Introduction:Diverse non-cigarette alternative tobacco products are increasingly
popular in the United States. This study investigates the reasons why young
adults initiate and continue the use of these products, as well as potential
motivations and approaches for quitting. Products assessed include cigarettes,
little cigars/cigarillos (LCCs), smokeless tobacco, e-cigarettes, and hookahs.

Methods:We conducted 60 telephone interviews, of 30-minute duration, with
tobacco users enrolled in colleges in Georgia. Qualitative analysis was used to
identify themes emerging from the data.

Results:Reasons for initiation, continued use, and (potential) cessation showed
similarities and differences across products. Most commonly cited reasons for
initiation included: peer influence (all products), flavors/tastes (all products except
cigarettes), and easy environmental access and/or low costs (LCCs, smokeless
tobacco, and e-cigarettes). Participants discussed several influences on continued
use, such as peer influence (cigarettes, LCCs, and hookahs), stress management
(all products except hookahs), and use with other substances (cigarettes, LCCs,
and hookahs). Primary motivations for cessation mentioned by participants were
family responsibilities (cigarettes, e-cigarettes, and hookahs) and health concerns
(all products except e-cigarettes). Frequently used cessation strategies included
avoidance of other tobacco users (cigarettes, LCCs, and hookahs) and a reduction
of nicotine intake (cigarettes and e-cigarettes).

Conclusions:Our findings suggest that researchers should consider the differences
in reasons for use and discontinued use of tobacco products in order to develop
targeted messaging strategies, particularly noting the differential impact of
interpersonal influences and health concerns. We also point to a need for
regulatory action that limits diversification and accessibility of different products.

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